UTIs in the Elderly: Symptoms and Treatment

Urinary tract infections, or UTIs, are the most common type of bacterial infection in older adults, affecting at least 10% of men and 20% of women older than 65. But seniors may experience different and more severe symptoms than younger adults do, including agitation, mental confusion, and sudden changes in behavior.

When left untreated, UTIs can cause serious problems in the elderly, including permanent kidney damage and sepsis, a generalized and potentially life-threatening infection.

Read on to understand how UTIs can affect the elderly and how to recognize symptoms of this common infection.

What are the symptoms of UTIs in the elderly?

Like anyone with a UTI, older adults may experience typical physical symptoms. Yet they may not notice a mild infection right away. This is because chronic urinary problems common in seniors, such as urinary incontinence or frequency, may have similar symptoms to a UTI, masking an infection.

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Common symptoms of a UTI include:

• Burning, painful sensation with urination
• Frequent, intense urge to urinate even when there’s little urine to pass
• A feeling that the bladder is not completely emptied
• Blood in the urine
• Cloudy or foul-smelling urine

Symptoms of a more severe UTI infection may include:

• Fever
• Night sweats or chills
• Nausea and vomiting
• Pain in the lower abdomen or back

When accompanied by other common UTI symptoms, sudden changes in behavior can also be key signs of a UTI in elderly adults, including:

• Confusion or delirium
• Sudden urinary incontinence
• Inability to perform common daily tasks, such as getting dressed or feeding themselves

Why do UTIs cause confusion in the elderly?

The immune system of an older adult reacts differently to infection compared to younger people. “A bladder infection places stress on the body,” says Dr. Mary Ann Forciea, an associate clinical professor at the University of Pennsylvania Health System in Philadelphia. That stress can result in confusion and abrupt changes in behavior in older adults with a UTI. And for those who have Alzheimer’s disease or other types of dementia, “any kind of stress, physical or emotional, will often make dementia temporarily worse,” Forciea says.

Why are seniors at risk for UTIs?

Men and women older than 65 are at greater risk for UTIs. This is because both men and women tend to have more problems emptying their bladder completely as they age. The urine sits in the bladder longer and bacteria develop.

In older men, this often happens because of a common condition called benign prostatic hyperplasia (BPH), or an enlarged prostate gland. The enlarged prostate blocks the flow of urine and prevents the bladder from fully emptying.

As women age, the bladder muscles weaken and prevent the bladder from emptying completely, increasing the risk of infection. Women also produce lower amounts of estrogen after menopause. This creates an imbalance of good and bad bacteria in the vagina, which can lead to infection.

Other risk factors for UTIs in older adults include:

• Using a catheter to empty the bladder
• Having kidney stones, which can block the flow of urine
• Having a suppressed immune system, which lowers the body’s defense against infection

How is a UTI diagnosed?

In older adults who have symptoms of a UTI, a simple urine test called a urinalysis can confirm infection. In some cases, the doctor requests a urine culture to identify the type of bacteria causing the infection and help determine the best antibiotic to treat it.

However, it’s important to know that older adults often have bacteria in the urine that don’t cause any symptoms. This condition is called asymptomatic bacteriuria, and it often resolves on its own without treatment.

Doctors now recommend against doing a urine test to check for a UTI, unless patients have typical, bothersome, typical UTI symptoms. This is to avoid the excessive use of antibiotics to treat infection, which can lead to antibiotic resistance.

How are UTIs treated in older adults?

Antibiotics are the first choice of treatment for UTIs. Mild UTIs often clear up in only a few days with the right antibiotic.

However, depending on the person’s age and health, and the severity of the infection, treatment for a UTI may take several weeks and a longer course of antibiotics. In more severe cases, older adults may need to be hospitalized to receive IV antibiotics.

If your loved one has symptoms of a UTI, it’s important to make an appointment with their doctor right away. If symptoms are severe, call the doctor immediately to determine whether a trip to the emergency room is necessary.

Reducing the risk of UTIs in seniors

Older adults can help prevent UTIs by drinking plenty of fluids to flush the bacteria from their systems, says Forciea. She recommends older adults drink four to six 8-ounce glasses of water a day. Drinking cranberry juice or taking cranberry tablets can also make urine less inviting for bacteria, Forciea says.

Women can also use these strategies to help prevent UTIs:

• Urinating promptly after the urge arises
• Wiping front to back
• Emptying the bladder shortly after sex
• Taking showers instead of baths

If your loved one has frequent UTIs or other challenges that require help with daily tasks, consider talking to one of our Senior Living Advisors about home care or senior living options that can improve their quality of life.

Sources:

Mody L. Approach to infection in the older adult. https://www.uptodate.com/contents/search.

Centers for Disease Control and Prevention. Urinary tract infection. https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/uti.html#anchor_1566489283094.

National Institute on Aging. Bladder health for older adults. https://www.nia.nih.gov/health/bladder-health-older-adults.

Mounton, C.P., et al. Common infections in older adults. American Family Physician, 2001: https://www.aafp.org/afp/2001/0115/p257.html.